ABSTRACT Objectives Intermediate‐risk (IR) non‐muscle‐invasive bladder cancer (NMIBC) is a heterogeneous disease. In this study, we aimed to evaluate the efficacy of photodynamic diagnosis (PDD)‐assisted transurethral resection of the bladder (TURBT) using the recently validated International Bladder Cancer Group (IBCG) risk stratification model for IR‐NMIBC. Methods We conducted a single‐center retrospective analysis of 193 patients with IR‐NMIBC who underwent either PDD‐assisted with oral 5‐aminolevulinic acid ( n = 69) or white‐light (WL) TURBT ( n = 126) between 2009 and 2023. We performed 1:1 propensity score matching (PSM) to balance baseline characteristics. Recurrence‐free survival (RFS) was compared between the groups using the Kaplan–Meier method with subgroup analyses based on IBCG risk strata (IR‐low, IR‐intermediate/high). Results After PSM, 69 patients with well‐balanced characteristics remained in each group. PDD was associated with a significantly improved RFS compared with WL‐TURBT in the overall cohort ( p = 0.016). Using subgroup analysis, this benefit was most pronounced in the IR‐low risk group ( p = 0.025), whereas no significant difference was found in the IR‐intermediate/high‐risk group ( p = 0.14). Regarding multivariate analysis, PDD was an independent predictor of improved RFS in both the entire IR cohort (hazard ratio HR: 0.421, p = 0.009) and IR‐low subgroup (HR: 0.361, p = 0.047). Conclusions PDD‐assisted TURBT significantly improved the recurrence outcomes in patients with IR‐NMIBC, with the greatest benefit observed in the IR‐low risk subgroup. These findings support a stratified approach in which PDD is a cornerstone of management of IR‐low patients, while highlighting the need for further research to optimize treatment strategies for IR‐intermediate/high patients.
Abe et al. (Fri,) studied this question.